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Miller JM, Zaun D, Wood NL, Lyden GR, McKinney WT, Hirose R, Snyder JJ. Adjusting for race in metrics of organ procurement organization performance. Am J Transplant 2024:S1600-6135(24)00122-9. [PMID: 38331046 DOI: 10.1016/j.ajt.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
The Scientific Registry of Transplant Recipients has previously reported the effects of adjusting for demographic variables, including race, in the Centers for Medicare & Medicaid Services (CMS) organ procurement organization (OPO) performance metrics: donation rate and transplant rate. CMS chose not to adjust for most demographic variables other than age (for the transplant rate), arguing that there is no biological reason that these variables would affect the organ donation/utilization decision. However, organ donation is a process based on altruism and trust, not a simple biological phenomenon. Focusing only on biological impacts on health ignores other pathways through which demographic factors can influence OPO outcomes. In this study, we update analyses of demographic adjustment on the OPO metrics for 2020 with a specific focus on adjusting for race. We find that adjusting for race would lead to 8 OPOs changing their CMS tier rankings, including 2 OPOs that actually overperform the national rate among non-White donors improving from a tier 3 ranking (facing decertification without possibility of recompeting) to a tier 2 ranking (allowing the possibility of recompeting). Incorporation of stratified and risk-adjusted metrics in public reporting of OPO performance could help OPOs identify areas for improvement within specific demographic categories.
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Affiliation(s)
- Jonathan M Miller
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA.
| | - David Zaun
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Nicholas L Wood
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA
| | - Grace R Lyden
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA
| | - Warren T McKinney
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ryutaro Hirose
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA; Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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2
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Wall SP, Castillo P, Shuchat-Shaw F, Norman E, Brown D, Martinez-López N, López-Ríos M, Seixas AA, Plass JL, Ravenell JE. Targeting versus Tailoring Educational Videos for Encouraging Deceased Organ Donor Registration in Black-Owned Barbershops. JOURNAL OF HEALTH COMMUNICATION 2022; 27:37-48. [PMID: 35170401 PMCID: PMC9050793 DOI: 10.1080/10810730.2022.2035021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the U.S., black men are at highest risk for requiring kidney transplants but are among those least likely to register for organ donation. Prior outreach used videos culturally targeted for Black communities, yet registration rates remain insufficient to meet demand. Therefore, we assessed whether generic versus videos culturally targeted or personally tailored based on prior organ donation beliefs differentially increase organ donor registration. In a randomized controlled trial, 1,353 participants in Black-owned barbershops viewed generic, targeted, or tailored videos about organ donation. Logistic regression models assessed the relative impact of videos on: 1) immediate organ donor registration, 2) taking brochures, and 3) change in organ donation willingness stage of change from baseline. Randomization yielded approximately equal groups related to demographics and baseline willingness and beliefs. Neither targeted nor tailored videos differentially affected registration compared with the generic video, but participants in targeted and tailored groups were more likely to take brochures. Targeted (OR = 1.74) and tailored (OR = 1.57) videos were associated with incremental increases in organ donation willingness stage of change compared to the generic video. Distributing culturally targeted and individually tailored videos increased organ donor willingness stage of change among Black men in Black-owned barbershops but was insufficient for encouraging registration.Abbreviations: CI - confidence interval; DMV - Department of Motor Vehicles; BOBs - Black-owned barbershops; ODBI - organ donation belief index; ODWS - organ donation willingness stage of change; OR - odds ratio.
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Affiliation(s)
- Stephen P. Wall
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Administration, Leadership, and Technology, NYU Steinhardt School of Culture, Education, and Human Development, New York, New York
| | - Patricio Castillo
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Francine Shuchat-Shaw
- Department of Administration, Leadership, and Technology, NYU Steinhardt School of Culture, Education, and Human Development, New York, New York
| | - Elizabeth Norman
- Department of Applied Statistics, Social Science, and Humanities, NYU Steinhardt School of Culture, Education, and Human Development, New York, New York
| | - David Brown
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Natalia Martinez-López
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Mairyn López-Ríos
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Milken Institute School of Public Health, George Washington University, Washington, D.C
| | - Azizi A. Seixas
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York
| | - Jan L. Plass
- Department of Administration, Leadership, and Technology, NYU Steinhardt School of Culture, Education, and Human Development, New York, New York
| | - Joseph E. Ravenell
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
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Crawshaw J, Li AH, Garg AX, Chassé M, Grimshaw JM, Presseau J. Identifying behaviour change techniques within randomized trials of interventions promoting deceased organ donation registration. Br J Health Psychol 2021; 27:822-843. [PMID: 34889488 DOI: 10.1111/bjhp.12575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Increasing deceased organ donation registration may increase the number of available organs for transplant to help save lives. This study aimed to identify which behaviour change techniques (BCTs; or 'active ingredients') are reported within randomized trials of interventions promoting deceased organ donation registration and of those, which are associated with a larger intervention effect. METHODS We conducted a secondary analysis of 45 trials included in a Cochrane systematic review of deceased organ donation registration interventions. Two researchers used the BCT Taxonomy v1 to independently code intervention content in all trial groups. Outcome data were pooled and we used meta-regression to explore associations between individual and combinations of recurring BCTs and effect on registration intention and/or registration behaviour. RESULTS A total of 27 different BCTs (mean = 3.7, range = 1-9) were identified in intervention groups across the 45 trials. The five most common BCTs were: 'Information about health consequences' (71%); 'Instruction on how to perform the behaviour' (47%); 'Salience of consequences' (40%); 'Adding objects to the environment' (28%); and 'Credible source' (27%). Comparator groups in 20/45 trials also included identifiable BCTs (n = 12, mean = 3.1, range = 1-7). Meta-regression revealed that a combination of the three most common BCTs was associated with a larger intervention effect size for registration behaviour (k = 8, β = .19, p = .02). CONCLUSIONS Trials of deceased organ donation registration interventions focus predominantly on providing information, instruction, and a means to register. While potentially effective, a much wider set of possible BCTs could be leveraged to address known barriers to registration.
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Affiliation(s)
- Jacob Crawshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada
| | - Alvin H Li
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
| | - Amit X Garg
- Lawson Health Research Institute, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine (Critical Care), University of Montreal Hospital, Quebec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ontario, Canada
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Wall SP, Castillo P, Shuchat Shaw F, Norman E, Martinez-Lopez N, Lopez-Rios M, Paulino H, Homer B, Plass JL, Ravenell JE. Including Medical Footage and Emotional Content in Organ Donation Educational Videos for Latinx Viewers. HEALTH EDUCATION & BEHAVIOR 2021; 49:424-436. [PMID: 34253089 DOI: 10.1177/10901981211022240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed whether videos with medical footage of organ preservation and transplantation plus sad, unresolved, or uplifting stories differentially affect deceased organ donor registration among clients in Latinx-owned barbershops and beauty salons. In a 2 × 3 randomized controlled trial, participants (N = 1,696, mean age 33 years, 67% female) viewed one of six videos. The control portrayed a mother who received a kidney (uplifting), excluding medical footage. Experimental videos included medical footage and/or showed a mother waiting (unresolved) or sisters mourning their brother's death (sad). Regression models assessed relative impact of medical footage and storylines on: (1) registry enrollment, (2) donation willingness stage of change, and (3) emotions. Randomization yielded approximately equal groups relative to age, sex, education, religion, nativity, baseline organ donation willingness, beliefs, and emotions. Overall, 14.8% of participants registered. Neither medical footage, sad, nor unresolved stories differentially affected registration and changes in organ donation willingness. Sad and unresolved stories increased sadness and decreased positive affect by ~0.1 logits compared with the uplifting story. Educational videos about organ donation which excluded or included medical footage and varying emotional valence of stories induced emotions marginally but did not affect viewers' registration decisions differently. Heterogeneity of responses within video groups might explain the attenuated impact of including medical footage and varying emotional content. In future work, we will report qualitative reasons for participants' registration decisions by analyzing the free text responses from the randomized trial and data from semistructured interviews that were conducted with a subset of participants.
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Affiliation(s)
- Stephen P Wall
- NYU Grossman School of Medicine, New York City, NY, USA.,NYU Steinhardt School of Culture, Education, and Human Development, New York City, NY, USA
| | | | - Francine Shuchat Shaw
- NYU Steinhardt School of Culture, Education, and Human Development, New York City, NY, USA
| | - Elizabeth Norman
- NYU Steinhardt School of Culture, Education, and Human Development, New York City, NY, USA
| | | | - Mairyn Lopez-Rios
- NYU Grossman School of Medicine, New York City, NY, USA.,George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Hehidy Paulino
- NYU Grossman School of Medicine, New York City, NY, USA.,Weill Cornell Medical College, New York City, NY, USA
| | - Bruce Homer
- The City University of New York, New York City, NY, USA
| | - Jan L Plass
- NYU Steinhardt School of Culture, Education, and Human Development, New York City, NY, USA
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5
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Kernodle AB, Zhang W, Motter JD, Doby B, Liyanage L, Garonzik-Wang J, Jackson KR, Boyarsky BJ, Massie AB, Purnell TS, Segev DL. Examination of Racial and Ethnic Differences in Deceased Organ Donation Ratio Over Time in the US. JAMA Surg 2021; 156:e207083. [PMID: 33566079 DOI: 10.1001/jamasurg.2020.7083] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Historically, deceased organ donation was lower among Black compared with White populations, motivating efforts to reduce racial disparities. The overarching effect of these efforts in Black and other racial/ethnic groups remains unclear. Objective To examine changes in deceased organ donation over time. Design, Setting, and Participants This population-based cohort study used data from January 1, 1999, through December 31, 2017, from the Scientific Registry of Transplant Recipients to quantify the number of actual deceased organ donors, and from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Detailed Mortality File to quantify the number of potential donors (individuals who died under conditions consistent with organ donation). Data were analyzed from December 2, 2019, to May 14, 2020. Exposures Race and ethnicity of deceased and potential donors. Main Outcomes and Measures For each racial/ethnic group and year, a donation ratio was calculated as the number of actual deceased donors divided by the number of potential donors. Direct age and sex standardization was used to allow for group comparisons, and Poisson regression was used to quantify changes in donation ratio over time. Results A total of 141 534 deceased donors and 5 268 200 potential donors were included in the analysis. Among Black individuals, the donation ratio increased 2.58-fold from 1999 to 2017 (yearly change in adjusted incidence rate ratio [aIRR], 1.05; 95% CI, 1.05-1.05; P < .001). This increase was significantly greater than the 1.60-fold increase seen in White individuals. Nevertheless, substantial racial differences remained, with Black individuals still donating at only 69% the rate of White individuals in 2017 (P < .001). Among other racial minority populations, changes were less drastic. Deceased organ donation increased 1.80-fold among American Indian/Alaska Native and 1.40-fold among Asian or Pacific Islander populations, with substantial racial differences remaining in 2017 (American Indian/Alaska Native population donation at 28% and Asian/Pacific Islander population donation at 85% the rate of the White population). Deceased organ donation differences between Hispanic/Latino and non-Hispanic/Latino populations increased over time (4% lower in 2017). Conclusions and Relevance The findings of this cohort study suggest that differences in deceased organ donation between White and some racial minority populations have attenuated over time. The greatest gains were observed among Black individuals, who have been the primary targets of study and intervention. Despite improvements, substantial differences remain, suggesting that novel approaches are needed to understand and address relatively lower rates of deceased organ donation among all racial minorities.
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Affiliation(s)
- Amber B Kernodle
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wanying Zhang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer D Motter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brianna Doby
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Kyle R Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allan B Massie
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Tanjala S Purnell
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.,Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
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6
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Li AH, Lo M, Crawshaw JE, Dunnett AJ, Naylor KL, Garg AX, Presseau J. Interventions for increasing solid organ donor registration. Cochrane Database Syst Rev 2021; 4:CD10829. [PMID: 35608942 PMCID: PMC8164549 DOI: 10.1002/14651858.cd010829.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND A solution for increasing the number of available organs for transplantation is to encourage more individuals to register a commitment for deceased organ donation. However, the percentage of the population registered for organ donation remains low in many countries. OBJECTIVES To evaluate the benefits and harms of various interventions used to increase deceased organ donor registration. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 11 August 2020 through contact with an Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included all randomised controlled trials (RCTs), cluster RCTs and quasi-RCTs of interventions to promote deceased organ donor registration. We included studies if they measured self-reported or verified donor registration, intention to donate, intention to register a decision or number of individuals signing donor cards as outcomes. DATA COLLECTION AND ANALYSIS Two authors independently assessed retrieved studies and extracted data from included studies. We assessed studies for risk of bias. We obtained summary estimates of effect using a random-effects model and expressed results as risk ratios (RR) (95% confidence intervals; CI) for dichotomous outcomes and mean difference (MD; 95% CI) or standardised mean difference (SMD; 95% CI) for continuous outcomes. In multi-arm trials, data were pooled to create single pair-wise comparisons. Analyses were stratified by specific intervention setting where available. MAIN RESULTS Our search strategy identified 46 studies (47 primary articles, including one abstract) comprising 24 parallel RCTs, 19 cluster RCTs and 3 quasi-RCTs. Sample sizes ranged from 138 to 1,085,292 (median = 514). A total of 16 studies measured registration behaviour, 27 measured intention to register/donate and three studies measured both registration behaviour and intention to register. Interventions were delivered in a variety of different settings: schools (14 studies), driver's motor vehicle (DMV) centres (5), mail-outs (4), primary care centres (3), workplaces (1), community settings (7) and general public (12). Interventions were highly varied in terms of their content and included strategies such as educational sessions and videos, leveraging peer leaders, staff training, message framing, and priming. Most studies were rated as having high or unclear risk of bias for random sequence generation and allocation concealment and low risk for the remainder of the domains. Data from 34/46 studies (74%) were available for meta-analysis. Low certainty evidence showed organ donation registration interventions had a small overall effect on improving registration behaviour (16 studies, 1,294,065 participants: RR 1.30, 95% CI 1.19 to 1.43, I2 = 84%), intention to register/donate (dichotomous) (10 studies, 10,838 participants: RR 1.21, 95% CI 1.03 to 1.42, I2 = 91%) and intention to register/donate (continuous) (9 studies, 3572 participants: SMD 0.23, 95% CI 0.11 to 0.36, I2 = 67%). Classroom-based interventions delivered in a lecture format by individuals from the transplant community may be effective at increasing intention to register/donate (3 studies, 675 participants: RR 1.33, 95% CI 1.15 to 1.55, I² = 0%). Community interventions targeting specific ethnic groups were generally effective at increasing registration rates (k = 5, n = 4186; RR 2.14, 95% CI 1.35 to 3.40, I² = 85%), although heterogeneity was high. In particular, interventions delivered in the community by trained peer-leaders appear to be effective (3 studies, 3819 participant: RR 2.09, 95% CI 1.08 to 4.06, I² = 87%), although again, the data lacked robustness. There was some evidence that framing messages (e.g. anticipated regret) and priming individuals (e.g. reciprocity) in a certain way may increase intention to register/donate, however, few studies measured this effect on actual registration. Overall, the studies varied significantly in terms of design, setting, content and delivery. Selection bias was evident and a quarter of the studies could not be included in the meta-analysis due to incomplete outcome data reporting. No adverse events were reported. AUTHORS' CONCLUSIONS In our review, we identified a variety of approaches used to increase organ donor registration including school-based educational sessions and videos, leveraging peer leaders in the community, DMV staff training, targeted messaging and priming. The variability in outcome measures used and incompleteness in reporting meant that most data could not be combined for analysis. When data were combined, overall effect sizes were small in favour of intervention groups over controls, however, there was significant variability in the data. There was some evidence that leveraging peer-leaders in the community to deliver organ donation education may improve registration rates and classroom-based education from credible individuals (i.e. members of the transplant community) may improve intention to register/donate, however, there is no clear evidence favouring any particular approach. There was mixed evidence for simple, low-intensity interventions utilising message framing and priming. However, it is likely that interest in these strategies will persist due to their reach and scalability. Further research is therefore required to adequately address the question of the most effective interventions for increasing deceased organ donor registration.
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Affiliation(s)
- Alvin H Li
- Department of Epidemiology and Biostatistics, Western University, London, Canada
| | - Marcus Lo
- London Health Sciences Centre, London, Canada
| | - Jacob E Crawshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Alexie J Dunnett
- Department of Medicine - Nephrology, London Health Sciences Centre, London, Canada
| | | | - Amit X Garg
- Department of Medicine, Epidemiology and Biostatistics, Western University, London, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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7
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Wadhwani SI, Brokamp C, Rasnick E, Bucuvalas JC, Lai JC, Beck AF. Neighborhood socioeconomic deprivation, racial segregation, and organ donation across 5 states. Am J Transplant 2021; 21:1206-1214. [PMID: 32654392 PMCID: PMC8191504 DOI: 10.1111/ajt.16186] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 01/25/2023]
Abstract
One in 10 people die awaiting transplantation from donor shortage. Only half of Americans register as organ donors. In this cross-sectional study, we evaluated population-level associations of neighborhood socioeconomic deprivation and racial segregation on organ donor registration rates. We analyzed state identification card demographic and organ donor registration data from 5 states to estimate the association between a neighborhood socioeconomic deprivation index (range [0, 1]; higher values indicate more deprivation) and a racial index of concentration at the extreme (ICE) (range [-1, 1]; lower values indicate predominantly black neighborhoods, higher values indicate predominantly white neighborhoods) on organ donor registration rates within a specified geography (census tract or ZIP code tabulation area [ZCTA]). Among 26 720 738 registrants, 32% of the sample were registered organ donors. At the census tract level, with each 0.1 decrease in the deprivation index, the organ donor registration rate increased by 6.8% (95% confidence interval [CI]: 6.6%, 7.0%). With each 0.1 increase in the racial ICE, the rate increased by 1.5% (95% CI: 1.5%, 1.6%). These associations held true at the ZCTA level. Areas with less socioeconomic deprivation and a higher concentration of white residents have higher organ donor registration rates. Public health initiatives should consider neighborhood context and novel data sources in designing optimal intervention strategies.
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Affiliation(s)
- Sharad I. Wadhwani
- University of California, San Francisco; San Francisco, CA,Cincinnati Children’s Hospital Medical Center; Cincinnati, OH
| | - Cole Brokamp
- Cincinnati Children’s Hospital Medical Center; Cincinnati, OH,University of Cincinnati College of Medicine; Cincinnati, OH
| | - Erika Rasnick
- Cincinnati Children’s Hospital Medical Center; Cincinnati, OH
| | - John C. Bucuvalas
- Icahn School of Medicine at Mount Sinai; New York, NY,Kravis Children’s Hospital at Mount Sinai; New York, NY
| | | | - Andrew F. Beck
- Cincinnati Children’s Hospital Medical Center; Cincinnati, OH,University of Cincinnati College of Medicine; Cincinnati, OH
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8
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Khoshravesh S, Karimi-Shahanjarini A, Poorolajal J, Bashirian S, Barati M, Hamidi M, Khalili S. Socio-Cultural Factors Contributing to Being an Organ Donor in Iranian Employees. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 42:171-179. [PMID: 33241985 DOI: 10.1177/0272684x20972836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The purpose of this study was to use a culturally modified Organ Donation Model (ODM) to explore the significant factors and ways in which these factors could influence signing the donor card. METHODS This cross-sectional study was conducted among 600 employees from 57 offices in Hamadan, Iran, in 2018. Participants were selected randomly and surveyed on being a donor and their perceptions regarding signing the donor card. Structural equation modeling (SEM) was conducted to determine the inter-relationship between the studied variables. RESULTS Participants' mean age was 39.5 (SD = 7.0). 20% of participants had a signed donor card. Descriptive norms (β = 0.53, p < 0.001), non-cognitive beliefs (β=-0.33, p < 0.001), anticipated regret (β = 0.28, p < 0.001) and subjective norms (β=-0.17, p < 0.01) had significant direct effects on signing the donor card. CONCLUSION This study provides socio-culturally informed evidence on individuals' signing donor card. These factors could provide a guide to policymakers to develop the community-based interventions.
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Affiliation(s)
- Sahar Khoshravesh
- Department of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Students Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Karimi-Shahanjarini
- Department of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical, Hamadan, Iran
| | - Saeed Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Barati
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Majid Hamidi
- Organ Donation Association, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sanaz Khalili
- Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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9
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Andrews AM, Zhang N, Smith AH, Loughery C, Resnicow K, Chapman R, Jenkins Riley H, Stav S, Yee J. A Clustered Randomized Trial Informing Patients on Dialysis About Their Ability to Donate Organs and Tissues. Prog Transplant 2020; 30:220-227. [PMID: 32567518 DOI: 10.1177/1526924820933840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The transplant waiting list exceeds the number of organs available. One means of increasing the organ pool is to broaden potential donors to include those with chronic diseases. RESEARCH QUESTIONS The study tested the effectiveness of using peer mentors to encourage individuals on dialysis to enroll on an organ donor registry. DESIGN Dialysis units were pair-matched by size and racial composition and then randomized to one of 2 interventions: meetings with a peer mentor (experimental intervention) or organ donation mailings (control). Peer mentors were trained to discuss organ donation with individuals on dialysis during in-person meetings at dialysis units. The primary outcome was verified registration in the state's donor registry. RESULTS After adjusting for age, gender, race, income, and education and accounting for correlation within the dialysis center, there was a significant intervention effect. Among individuals in the intervention group, the odds of enrolling (verified) on the donor registry were 2.52 times higher than those in the control group. DISCUSSION The use of peer mentors to discuss donating organs after death with individuals on dialysis can increase enrollment on a donor registry. Dispelling myths about chronic illness and donation can counter widely held misconceptions and help persons make an informed choice about end-of-life decisions and present an opportunity to increase the number of organs and tissues available for transplant.
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Affiliation(s)
- Ann M Andrews
- 456953National Kidney Foundation of Michigan, Ann Arbor, MI, USA
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, 2518University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Caitlin Loughery
- 456953National Kidney Foundation of Michigan, Ann Arbor, MI, USA
| | - Ken Resnicow
- Department of Health Behavior & Health Education, 51329University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Remonia Chapman
- Gift of Life Michigan, Minority Organ and Tissue Transplant Education Program, Ann Arbor, MI, USA
| | | | - Sheri Stav
- Greenfield Health Systems, Bingham Farms, MI, USA
| | - Jerry Yee
- 2971Henry Ford Health System, Detroit, MI, USA
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Nonterah CW, Gardiner HM. Pre-transplant evaluation completion for Black/African American renal patients: Two theoretical frameworks. PATIENT EDUCATION AND COUNSELING 2020; 103:988-998. [PMID: 31733984 DOI: 10.1016/j.pec.2019.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Black/African Americans (B/AA) are less likely to complete the pre-transplant evaluation for kidney transplantation despite higher prevalence rates of end-stage renal disease (ESRD). To better understand the barriers and motivators to completing the evaluation process, two qualitative studies were conducted to categorize and elucidate the relationships between these factors. METHODS In Phase I, semi-structured interviews were conducted with a stratified purposeful sample of transplant professionals (N = 23). Focus groups were conducted during Phase II with a purposeful sample of B/AA patients (N = 30). RESULTS Thematic analyses assessed using grounded theory revealed a multitude of factors at individual and systemic levels, including health and informational/educational-related factors. Two comprehensive theoretical frameworks, a socio-ecological model of barriers and a model of motivators are presented. Medical mistrust is an example of a community factor identified as impeding completion rates. Systemic motivators included compressed time for testing and fewer intervals between doctor's appointments. CONCLUSIONS This study offers a structure for understanding impediments to and facilitators of pre-transplant evaluation completion as seen through the eyes of both B/AA ESRD patients seeking transplant and the providers who work with them. PRACTICE IMPLICATIONS Recommendations for intervention and systemic changes to narrow health disparities are discussed.
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Affiliation(s)
- Camilla W Nonterah
- University of Richmond, 114 UR Drive, Richmond, 23173-0001, United States.
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Čož S, Kamin T. Systematic Literature Review of Interventions for Promoting Postmortem Organ Donation From Social Marketing Perspective. Prog Transplant 2020; 30:155-168. [DOI: 10.1177/1526924820913509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: This systematic review examines the factors that make some interventions promoting postmortem organ donation more successful and more likely to change behaviors than others. We analyzed the effectiveness of different types of interventions for promoting postmortem organ donation against the criteria identified by previous research in other health-related areas as the most important for designing effective behavior change programs. We observed a correlation between the use of social marketing benchmarks and the reported success of intervention goals. Methods: We conducted a systematic review of all articles describing interventions promoting postmortem organ donation published in scientific journals between January 2008 and November 2018. We analyzed these articles against the 7 social marketing benchmark criteria using a coding questioner. Findings: The analysis revealed a correlation between the use of social marketing benchmark criteria in an intervention’s design and the success of the intervention. Interventions that employed 6 or 7 criteria reported successful achievement of all intervention objectives. We observed a decrease in success rates when fewer than 6 social marketing benchmark criteria were included in the intervention design. Discussion: The findings suggest that a social marketing approach may prove useful to efforts to promote postmortem organ donation. More social marketing benchmark criteria should be included in the design and implementation of interventions promoting postmortem organ donation.
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Affiliation(s)
- Sinja Čož
- Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Kamin
- Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
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Loughery C, Zhang N, Resnicow K, Chapman R, Magee JC, Andrews AM. Peer Leaders Increase Organ Donor Designation Among Members of Historically African American Fraternities and Sororities. Prog Transplant 2017; 27:369-376. [DOI: 10.1177/1526924817732022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Health education programs can positively impact organ donor designation among African Americans, a disproportionately represented group on the transplant waiting list. Alumni chapters of historically African American sororities and fraternities are a novel setting for organ donation education and research. Research Questions: This study tested the effectiveness of a lay health advisor model to increase donor designation registrations on the Michigan Organ Donor Registry among members of Midwest alumni chapters. The secondary outcome was change in attitudes toward donation assessed by pre–post questionnaire. Design: Sorority/fraternity members were trained to deliver educational presentations during a 12-month period. Follow-up messaging consisted of tailored newsletters and e-mails. A cluster randomized design was utilized with 25 chapters (16 sororities and 9 fraternities) assigned to intervention (organ donation) or comparison (chronic disease). Results: Odds of signing up for the donor registry were 1.45 times higher for the intervention group than the comparison group. Among those identified as nondonors at baseline, the odds of signing up were 1.58 times higher for intervention than comparison. Discussion: Using lay health advisors in African American sororities and fraternities can increase enrollment in a donor registry. Alumni chapters offer a unique and viable setting for organ donation education and research; relationship building with chapter officials is key to success.
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Affiliation(s)
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ken Resnicow
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Remonia Chapman
- Gift of Life Michigan, Minority Organ and Tissue Transplant Education Program, Ann Arbor, MI, USA
| | - John C. Magee
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ann M. Andrews
- National Kidney Foundation of Michigan, Ann Arbor, MI, USA
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Uber A, Sadler RC, Chassee T, Reynolds JC. Bystander Cardiopulmonary Resuscitation Is Clustered and Associated With Neighborhood Socioeconomic Characteristics: A Geospatial Analysis of Kent County, Michigan. Acad Emerg Med 2017; 24:930-939. [PMID: 28493598 DOI: 10.1111/acem.13222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/01/2017] [Accepted: 04/13/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Geographic clustering of bystander cardiopulmonary resuscitation (CPR) is associated with demographic and socioeconomic features of the community where out-of-hospital cardiac arrest (OHCA) occurred, although this association remains largely untested in rural areas. With a significant rural component and relative racial homogeneity, Kent County, Michigan, provides a unique setting to externally validate or identify new community features associated with bystander CPR. Using a large, countywide data set, we tested for geographic clustering of bystander CPR and its associations with community socioeconomic features. METHODS Secondary analysis of adult OHCA subjects (2010-2015) in the Cardiac Arrest Registry to Enhance Survival (CARES) data set for Kent County, Michigan. After linking geocoded OHCA cases to U.S. census data, we used Moran's I-test to assess for spatial autocorrelation of population-weighted cardiac arrest rate by census block group. Getis-Ord Gi statistic assessed for spatial clustering of bystander CPR and mixed-effects hierarchical logistic regression estimated adjusted associations between community features and bystander CPR. RESULTS Of 1,592 subjects, 1,465 met inclusion criteria. Geospatial analysis revealed significant clustering of OHCA in more populated/urban areas. Conversely, bystander CPR was less likely in these areas (99% confidence) and more likely in suburban and rural areas (99% confidence). Adjusting for clinical, demographic, and socioeconomic covariates, bystander CPR was associated with public location (odds ratio [OR] = 1.19; 95% confidence interval [CI] = 1.03-1.39), initially shockable rhythms (OR = 1.48; 95% CI = 1.12-1.96), and those in urban neighborhoods (OR = 0.54; 95% CI = 0.38-0.77). CONCLUSIONS Out-of-hospital cardiac arrest and bystander CPR are geographically clustered in Kent County, Michigan, but bystander CPR is inversely associated with urban designation. These results offer new insight into bystander CPR patterns in mixed urban and rural regions and afford the opportunity for targeted community CPR education in areas of low bystander CPR prevalence.
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Affiliation(s)
- Amy Uber
- Department of Emergency Medicine; Beth Israel Deaconess Medical Center; Boston MA
- Michigan State University College of Human Medicine; Grand Rapids MI
| | - Richard C. Sadler
- Department of Family Medicine; Michigan State University College of Human Medicine; Flint MI
| | - Todd Chassee
- Michigan State University College of Human Medicine; Grand Rapids MI
- Kent County Emergency Medical Services, Inc.; Grand Rapids MI
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Golding SE, Cropley M. A Systematic Narrative Review of Effects of Community-Based Intervention on Rates of Organ Donor Registration. Prog Transplant 2017; 27:295-308. [DOI: 10.1177/1526924817715461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The demand for organ donation is increasing worldwide. One possible way of increasing the pool of potential posthumous donors is to encourage more members of the general public to join an organ donor registry. Objective: A systematic review was conducted to investigate the effectiveness of psychological interventions designed to increase the number of individuals in the community who register as organ donors. Methods: PsycINFO and PubMed databases were searched. No date limits were set. Randomized and nonrandomized controlled trials exploring the effects of community-based interventions on organ donor registration rates were included. Methodological quality was assessed using the “Quality Assessment Tool for Quantitative Studies.” Results: Twenty-four studies met the inclusion criteria; 19 studies found a positive intervention effect on registration. Only 8 studies were assessed as having reasonable methodological robustness. A narrative synthesis was conducted. Factors influencing registration rates include providing an immediate registration opportunity and using brief interventions to challenge misconceptions and concerns about organ donation. Discussion: Community-based interventions can be effective at increasing organ donor registrations among the general public. Factors that may increase effectiveness include brief interventions to address concerns and providing an immediate registration opportunity. Particular consideration should be paid to the fidelity of intervention delivery. Protocol registration number: CRD42014012975.
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Affiliation(s)
- Sarah Elizabeth Golding
- Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Mark Cropley
- Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, Guildford, United Kingdom
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15
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Melnikov S, Ashkenazi T, Amara M, Peles Bortz A. Transcendental Spirituality and Acquaintance With the Activities of the Domestic National Transplant Center as Factors Shaping Attitudes Toward Organ Donation. Prog Transplant 2017; 27:139-145. [DOI: 10.1177/1526924817699967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Context: Organ donation has been shown to be perceived as inappropriate by religiously observant individuals. The impact of spirituality level on attitudes toward organ donation has not been broadly explored. Objective: To explore the contribution of ethnicity, spirituality, level of religious observance, and acquaintance with the activities of the Israel National Transplant Center (INTC) to forming attitudes toward organ donation among Jews and Muslim Arabs in Israel. Design: A descriptive cross-sectional survey. Participants: Three hundred five (65.2%) Jewish and 163 (34.8%) Muslim Arab respondents living in Israel. Results: Jewish respondents had more positive attitudes toward organ donation than Muslim Arabs. Muslim Arabs had a higher mean spirituality score than Jews. Gender, age, ethnicity, level of religious observance, education, 4 spirituality dimensions, and acquaintance with the activities of the INTC explained 41.5% of the variance in attitudes to organ donation. Transcendental spirituality, acquaintance with the activities of the INTC, and level of religious observance had the highest contribution to explaining attitudes to organ donation, while gender and age had a low contribution. Ethnicity, education, and the 3 other spirituality dimensions were not found to have a significant contribution. Conclusion: A multifaceted approach to improving attitudes toward organ donation among Jews and Muslim Arabs in Israel is important.
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Affiliation(s)
- Semyon Melnikov
- Department of Nursing, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Ashkenazi
- Israel National Transplant Center, Ministry of Health, Tel Aviv, Israel
| | - Muhammad Amara
- Imam of Israeli Arab Village of Zalafa, Zalafa, Ma’ale Iron, Israel
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Morgan M, Kenten C, Deedat S, Farsides B, Newton T, Randhawa G, Sims J, Sque M. Increasing the acceptability and rates of organ donation among minority ethnic groups: a programme of observational and evaluative research on Donation, Transplantation and Ethnicity (DonaTE). PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BackgroundBlack, Asian and minority ethnic (BAME) groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks.ObjectiveTo identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent.MethodsThree-phase programme comprising (1) community-based research involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; (2) hospital-based research examining staff practices and influences on family consent through ethics discussion groups (EDGs) with staff, a study on intensive care units (ICUs) and interviews with bereaved ethnic minority families; and (3) development and evaluation of a training package to enhance cultural competence among ICU staff.SettingCommunity focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts (three in London and two in Midlands).Participants(1) Community studies: 228 focus group participants; (2) hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and (3) evaluation: 66 health professionals.Data sourcesFocus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation.Review methodsSystematic review and narrative synthesis.Results(1) Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. (2) Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation (SNOD) reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory (or cardiac) death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. (3) Evaluation: professional development package – a digital versatile disc-based training package was developed to promote confidence and skills in cross-cultural communication (available at:www.youtube.com/watch?v=ueaR6XYkeVM&feature=youtu.be). Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation.LimitationsParticipants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families.ConclusionsThe research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS.Future workGreater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Myfanwy Morgan
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Charlotte Kenten
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Sarah Deedat
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Tim Newton
- Dental Institute, King’s College London, London, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Jessica Sims
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Magi Sque
- Faculty of Education, Health and Wellbeing, University of Wolverhampton and Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Ralph AF, Alyami A, Allen RDM, Howard K, Craig JC, Chadban SJ, Irving M, Tong A. Attitudes and beliefs about deceased organ donation in the Arabic-speaking community in Australia: a focus group study. BMJ Open 2016; 6:e010138. [PMID: 26787253 PMCID: PMC4735320 DOI: 10.1136/bmjopen-2015-010138] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To describe the beliefs and attitudes to organ donation in the Arabic-speaking community. DESIGN Arabic-speaking participants were purposively recruited to participate in 6 focus groups. Transcripts were analysed thematically. PARTICIPANTS 53 participants, aged 19-77 years, and originating from 8 countries, participated in 1 of 6 focus groups. Participants identified as Christian (73%), Islam (26%), Buddhist (2%) or did not identify with any religion (2%). RESULTS 6 themes (with subthemes) were identified; religious conviction; invisibility of organ donation; medical suspicion; owning the decision; and reciprocal benefit. CONCLUSIONS Although organ donation is considered a generous life-saving 'gift', representative members of the Arabic-speaking community in Australia were unfamiliar with, unnerved by and sceptical about the donation process. Making positive decisions about organ donation would likely require resolving tensions between respecting family, community and religious values versus their individual autonomy. Providing targeted education about the process and benefits of organ donation within the Arabic community may clarify ambiguities surrounding cultural and religious-based views on organ donation, reduce taboos and suspicion towards donation, and in turn, lead to increased organ donation rates.
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Affiliation(s)
- Angelique F Ralph
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ali Alyami
- Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia Transplantation Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Richard D M Allen
- Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia Transplantation Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kirsten Howard
- The Institute for Choice, University of South Australia, North Sydney, New South Wales, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Steve J Chadban
- Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia Transplantation Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michelle Irving
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Ladin K, Wang R, Fleishman A, Boger M, Rodrigue JR. Does Social Capital Explain Community-Level Differences in Organ Donor Designation? Milbank Q 2015; 93:609-41. [PMID: 26350932 DOI: 10.1111/1468-0009.12139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/29/2022] Open
Abstract
POLICY POINTS The growing shortage of life-saving organs has reached unprecedented levels, with more than 120,000 Americans waiting for them. Despite national attempts to increase organ donation and federal laws mandating the equitable allocation of organs, geographic disparities remain. A better understanding of the contextual determinants of organ donor designation, including social capital, may enhance efforts to increase organ donation by raising the probability of collective action and fostering norms of reciprocity and cooperation while increasing costs to defectors. Because community-level factors, including social capital, predict more than half the variation in donor designation, future interventions should tailor strategies to specific communities as the unit of intervention. CONTEXT The growing shortage of organs has reached unprecedented levels. Despite national attempts to increase donation and federal laws mandating the equitable allocation of organs, their availability and waiting times vary significantly nationwide. Organ donor designation is a collective action problem in public health, in which the regional organ supply and average waiting times are determined by the willingness of individuals to be listed as organ donors. Social capital increases the probability of collective action by fostering norms of reciprocity and cooperation while increasing costs to defectors. We examine whether social capital and other community-level factors explain geographic variation in organ donor designation rates in Massachusetts. METHODS We obtained a sample of 3,281,532 registered drivers in 2010 from the Massachusetts Department of Transportation Registry of Motor Vehicles (MassDOT RMV). We then geocoded the registry data, matched them to 4,466 census blocks, and linked them to the 2010 US Census, the American Community Survey (ACS), and other sources to obtain community-level sociodemographic, social capital (residential segregation, voter registration and participation, residential mobility, violent-death rate), and religious characteristics. We used spatial modeling, including lagged variables to account for the effect of adjacent block groups, and multivariate regression analysis to examine the relationship of social capital and community-level characteristics with organ donor designation rates. FINDINGS Block groups with higher levels of social capital, racial homogeneity, income, workforce participation, owner-occupied housing, native-born residents, and white residents had higher rates of organ donor designation (p < 0.001). These factors remained significant in the multivariate model, which explained more than half the geographic variance in organ donor designation (R(2) = 0.52). CONCLUSIONS The findings suggest that community-level factors, including social capital, predict more than half the variation in donor designation. Future interventions should target the community as the unit of intervention and should tailor messaging for areas with low social capital.
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Affiliation(s)
- Keren Ladin
- Tufts University.,Tufts University Medical School
| | | | | | | | - James R Rodrigue
- Harvard Medical School.,Transplant Institute, Beth Israel Deaconess Medical Center
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Community-Based Interventions and Individuals' Willingness to be a Deceased Organ Donor: Systematic Review and Meta-Analysis. Transplantation 2015; 99:2634-43. [PMID: 26356178 DOI: 10.1097/tp.0000000000000897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Widespread in-principle community support for organ donation does not necessarily translate to individuals becoming organ donors after death. Previous studies have identified factors that influence individuals' decisions to become organ donors, which may be effectively targeted by interventions. We aimed to describe and evaluate the effectiveness of community-based interventions to increase the willingness of individuals to be a deceased organ donor. METHODS We systematically reviewed all randomized controlled trials (RCTs), non-RCTs (NRCTs), and before-after studies that assessed the impact of interventions on increasing the willingness to be a deceased organ donor (measured as commitment to donate and/or intention to donate). We searched MEDLINE, Embase, PsycINFO, and CINAHL, without language restriction, to December 2013 and the reference lists of the included articles. We conducted a risk of bias assessment using the Cochrane risk of bias tools and assessed confidence in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation framework. RESULTS We identified 63 studies (11 RCTs, 8 cluster-RCTs, 4 NRCTs, 8 cluster-NRCTs, 27 before-after studies) with over 170,000 participants. Overall, the quality of the evidence was low. Participants who received a broad range of community-based interventions were more likely to commit as donors (7 cluster-RCTs; 6015 participants; relative risk, 1.70; 95% confidence interval [95% CI], 1.22-2.36; I = 94%, P = 0.002), and had higher levels of willingness to donate (3 RCTs, 393 participants; standardized mean difference, 0.29; 95% CI, 0.01-0.56; I = 45%; P = 0.04) than those who did not receive the interventions, but not the intention to donate (315 participants; relative risk, 1.19; 95% CI, 0.94-1.51; P = 0.14). CONCLUSIONS Community partnerships and active learning community-based interventions may be effective in increasing the commitment, but not intentions to donate. However, the overall risk of bias for was high, and this may have led to overestimation of the relative treatment effects of these interventions.
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Langford AT, Resnicow K, Beasley DD. Outcomes from the Body & Soul Clinical Trials Project: a university-church partnership to improve African American enrollment in a clinical trial registry. PATIENT EDUCATION AND COUNSELING 2015; 98:245-50. [PMID: 25468392 PMCID: PMC4293033 DOI: 10.1016/j.pec.2014.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/10/2014] [Accepted: 10/20/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Historically, African Americans have been underrepresented in clinical trials (CTs) compared to whites. A growing number of research institutions have created CT registries to match volunteers with appropriate studies. In a sample of 745 African Americans from 16 churches, we tested the impact of a culturally tailored intervention aimed at increasing enrollment in a university-based CT registry. METHODS Half of the churches received a culturally tailored CT education program (intervention) and half of the churches received a program about healthy eating (comparison). The main outcomes were the odds of post-test self-reported enrollment and verified enrollment. Using linear regression, post-test willingness to participate in a CT was also assessed. RESULTS Odds of verified enrollment were higher in the intervention than comparison group (OR=2.95, 95% CI: 1.33-6.5, p=0.01). Post-test self-reported enrollment in the registry was also higher among the intervention group than comparison group members (OR=1.94, 95% CI: 1.08-3.47, p=0.03). Willingness to participate in a future CT was higher in the intervention group (β=0.74, p=0.02). CONCLUSIONS A culturally tailored education program about CTs can increase enrollment of African Americans in a university-based clinical trials registry. PRACTICE IMPLICATIONS Community engagement and health education workshops may improve minority CT enrollment over time.
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Affiliation(s)
- Aisha T Langford
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor, Ann Arbor, USA.
| | - Ken Resnicow
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, USA
| | - Derrick D Beasley
- Department of Behavioral Sciences & Health Education, Rollins School of Public Health of Emory University, Atlanta, USA
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Robinson DHZ, Arriola KRJ. Strategies to facilitate organ donation among African Americans. Clin J Am Soc Nephrol 2015; 10:177-9. [PMID: 25635039 DOI: 10.2215/cjn.12561214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cassel KD, Braun K, Ka'opua L, Soa F, Nigg C. Samoan body and soul: adapting an evidence-based obesity and cancer prevention program. QUALITATIVE HEALTH RESEARCH 2014; 24:1658-72. [PMID: 25212854 PMCID: PMC4698459 DOI: 10.1177/1049732314549021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Obesity-associated chronic diseases persist in Samoan populations in the United States. Samoans and African Americans share cultural similarities such as church affiliation, perceptions of weight and body size, and obesity-related health risks. Adapting an effective energy balance intervention originally designed for African Americans--Body and Soul--might be useful in reducing obesity among U.S. Samoans. To determine potential attractiveness and adaptations, we used aspects of grounded theory to analyze key-informant and focus group interviews with 31 purposively selected Samoans in Hawaii. We incorporated participatory features into the research with Samoan community members conducting parts of the study. From interview narratives, we identified relevant themes from Samoan culture, such as "fa'aSamoa", or the Samoan way, and specific energy balance activities to include in an obesity and cancer prevention intervention for U.S.-dwelling Samoans. Our findings describe methods to address health disparities by incorporating culturally appropriate health concepts into existing evidence-based interventions.
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Affiliation(s)
- Kevin D Cassel
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Kathryn Braun
- University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Lana Ka'opua
- University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Fuamaila Soa
- Windward Samoan Congregational Christian Church, Waimanalo, Hawaii, USA
| | - Claudio Nigg
- University of Hawaii at Manoa, Honolulu, Hawaii, USA
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Deedat S, Kenten C, Morgan M. What are effective approaches to increasing rates of organ donor registration among ethnic minority populations: a systematic review. BMJ Open 2013; 3:e003453. [PMID: 24362010 PMCID: PMC3884619 DOI: 10.1136/bmjopen-2013-003453] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/04/2013] [Accepted: 10/09/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify effective interventions to increase organ donor registration and improve knowledge about organ donation among ethnic minorities in North America and the UK. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane Central searched up to November 2012, together with four trials databases and the grey literature. REVIEW METHODS A systematic search followed by assessment of eligibility and quality. An interpretive and thematic approach to synthesis was undertaken. This examined the nature and delivery of interventions in relation to a range of outcomes: verified registration, changing knowledge and a measured shift towards greater readiness. RESULTS 18 studies were included in the review, comprising educational and mass media interventions. Mass media interventions alone reported no significant change in the intention or willingness to register. Educational interventions either alone or combined with mass media approaches were more effective in increasing registration rates, with a strong interpersonal component and an immediate opportunity to register identified as important characteristics in successful change. CONCLUSIONS Effective interventions need to be matched to the populations' stage of readiness to register. Measured outcomes should include registration and shifts along the pathway towards this behavioural outcome.
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Affiliation(s)
- Sarah Deedat
- Department of Primary Care & Public Health Sciences, King's College London, London, UK
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Sasson C, Meischke H, Abella BS, Berg RA, Bobrow BJ, Chan PS, Root ED, Heisler M, Levy JH, Link M, Masoudi F, Ong M, Sayre MR, Rumsfeld JS, Rea TD. Increasing Cardiopulmonary Resuscitation Provision in Communities With Low Bystander Cardiopulmonary Resuscitation Rates. Circulation 2013; 127:1342-50. [DOI: 10.1161/cir.0b013e318288b4dd] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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